American Indian (Al) children face a number of disparities in health and health care. One area that has received little attention is the use of and care provided to Al children at the emergency department (ED). The little research that has been performed suggests that Al children have increased usage of the ED, increased rates of leaving without care, and possible differential care provided within the ED setting. This study aims to more fully understand and characterize the patterns of ED use and care for Al children in the Upper Midwest and develop interventions to address issues that are unexplored to date. We will partner with a collection of EDs throughout the Upper Midwest as well as Al communities within the catchment area of these EDs. Through our partners, we will gather data from the hospitals to help clarify usage and care practices and gather feedback from the care providers within the EDs. We will also go into the communities to talk to Al parents, guardians, and elders to obtain their perspectives on ED use and care provided. The information collected will be used to develop interventions to help improve ED use and care for Al children. This study is unique in examining the use and care provided to Al children in the ED. While studies have explored disparities in ED usage and care for other minority groups, none have focused specifically on Al children. No interventions within the ED have yet been proposed or developed specific to this population, which is a critical need this proposal will meet.